Thyroid pain is any discomfort or pain emanating from the thyroid gland due to disease processes within the gland or rarely due to neighboring structures in the neck and upper thorax affecting the thyroid gland. Often pain in the thyroid gland is not identified as such if other signs of symptoms of thyroid dysfunction are not clearly evident. Pathology in any one of the surrounding neck structures, like the neck muscles, larynx, trachea, esophagus, cervical lymph nodes and even the blood vessels, will cause pain in the area.
Other Symptoms with Thyroid Pain
Thyroid pain may vary in intensity from discomfort that is described as tightness especially when swallowing to a dull ache throughout the gland that exacerbates when palpated (tenderness). Acute thyroid pain is uncommon in cases other than viral thyroiditis but persistent pain can be prominent enough to be one of the indications for medical or surgical intervention. Thyroid pain may be accompanied by other clinical features like :
- Enlarged thyroid gland (goiter) that appears as an anterior neck mass
- Discomfort (dysphagia) or pain (odynophagia) when swallowing
- Hoarse voice
- Signs and symptoms of thyrotoxiosis (hyperthyroid) – diarrhea, tremors, irritability, insomnia, weight loss, sensitivity to heat, sweating
- Signs and symptoms of hypothyroidism – constipation, depression, weight gain, menstrual irregularity (women), fatigue, intolerance to cold, dry thinning hair and brittle nails
Thyroid Pain Location
The thyroid gland is located between the C5 and T1 vertebrae. However, since the position of the thyroid gland can vary slightly among people, changes position during swallowing and can be enlarged (goiter), it is difficult to use the vertebral column as the sole landmark.
Thyroid pain is any superficial discomfort, tenderness or pain in the neck, below the thyroid cartilage (Adam’s apple) around the level of the cricoid cartilage that is usually exacerbated during swallowing or palpation. This tenderness or pain can extend all the way to the superior mediastinum. However the pain may not be so localized and could radiate to laterally (sternocleidomastoid muscles), superiorly (mouth, chin, jaw) or inferiorly (beyond the superior mediastinum to the chest).
In some cases, thyroid pain can lie almost entirely behind the sternum (retrosternal) although tenderness will be detected in the neck during palpation. Depending on the cause, the pain can be localized to a small area of the thyroid gland whereas in other conditions the pain may be evident throughout the gland.
Causes of Thyroid Pain
Most cases of thyroid pain can be attributed to thyroiditis – inflammation of the thyroid gland. Pain is a typical feature of inflammation and is most prominent in acute and subacute thyroiditis. It may be a temporary feature in the early stages of the disease or persist throughout the course of the disease. This includes :
- Acute infectious thyroiditis (mainly viral)
- Subacute granulomatous thyroiditis (de Quervain’s thyroiditis)
- Hashimoto’s thyroiditis (not always present)
The clinical presentation is discussed further under Thyroiditis Symptoms.
Identifying the cause of thyroid pain is difficult without assessing other concomitant signs and symptoms. Thyroiditis, a bleeding thyroid cyst and advanced stages of thyroid cancer are conditions where thyroid pain is prominent and clearly evident.
Thyroid pain may not be prominent or present at all in other thyroid diseases, yet some patients with these painless thyroid conditions may report severe thyroid pain. In other cases the thyroid pain may only be evident upon swallowing and should be considered under odynophagia (painful swallowing). It is also important to consider other causes of anterior neck pain that are not related to any thyroid disease.